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During the treatment of critically ill COVID-19 patients it has been revealed that the neutralizing monoclonal antibodies against 2019-nCoV have the advantages of high specificity, high purity, and can be prepared in a large scale, which are expected to be a effective preparation for clinical use. This article introduces the way of 2019-nCoV invasion into the host cells, the major variants of novel coronavirus, and the mechanism of action of anti-2019-nCoV monoclonal antibodies, as well as the progress of research and development of their preparation in major pharmaceutical companies, to provide reference for scientific research and clinical application.
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@#The Streptococcus mutans (S. mutans) phage, as one of the principal pathogenic bacteria of dental caries, is a main cause of the formation and development of dental caries due to its overproliferation in dental plaque biofilms. Bacterial viruses, also known as bacteriophages, have the capability of specifically infecting bacteria and effectively degrading bacterial biofilms. S. mutans phages, therefore, may prevent and control caries. Therapy based on phages has been applied in many fields, but the application of S. mutans phages in caries remains exploratory. This article will review the research progress of S. mutans phages in clinical caries prevention, aiming to provide a new idea for the clinical prevention of caries. The results of the literature review show that the living bacteriophage system has the advantages of high specificity, high affinity and good safety. However, due to its unstable structure, it can be processed into a more stable formulation by freeze-drying, spray drying, adding stability enhancers, or incorporating bacteriophages into ointments, biodegradable polymer matrices or particles to a certain extent to improve stability. The lysozyme produced by phages can digest the bacterial cell wall and release the assembled phage particles, which effectively cleave biofilms. In addition, the antigen binding fragment library for cariogenic pathogens was screened by phage display technology, and the purpose of caries prevention and treatment was achieved by passive immunization of antigen binding fragments. However, the host range of bacteriophages is narrow, so this kind of problem can be overcome by phage combined with traditional therapy or other drug use or cocktail therapy with multiple phages in clinical caries prevention and control.
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OBJECTIVES@#To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA).@*METHODS@#A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed.@*RESULTS@#VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all <0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both <0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (=0.027).@*CONCLUSIONS@#The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.
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Humans , Analgesics , Arthroplasty, Replacement, Knee , Injections, Intra-Articular , Osteoarthritis, Knee , General Surgery , Pain Measurement , Pain, PostoperativeABSTRACT
Objective: To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA). Methods: Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups ( n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups ( P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups. Results: The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A ( P0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B ( P0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups ( χ2=1.721, P=0.550). Conclusion: For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.
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BACKGROUND: Steroids have strong anti-inflammatory, anti-emetic and analgesic effects and are widely used in perioperative analgesia. Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain, improve knee activity, and reduce complications. However, the other studies show that steroids can increase the risk of postoperative infection, and tendon rupture. Therefore, the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial. OBJECTIVE: To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis. METHODS: The published literatures were searched on the databases of PubMed/Medline, Cochrane Central Register of Controlled Trials, and EMBASE until April 2019. All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened. Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0. The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software. RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled articles involving 820 patients were included. (2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52, 95%C/(-2.94, -0.10), P=0.04]. Motion range was higher in the steroid group than in the control group at postoperative 1, 2, 3,4 and 5 days [MD=11.57, 95%C/(9.85, 13.30), P < 0.000 01; MD=9.03, 95%C/(B.67, 11.38), P < 0.000 01; MD=5.73, 95%C/(0.85, 10.60), P=0.02; MD=5.53, 95%C/(0.68, 10.38), P=0.03); MD=5.90, 95%C/(0.87, 10.93), P=0.02j. Morphine use was less in the steroid group than in the control group [MD=-7.94, 95%C/(-14.35, -1.53), P=0.02j. Hospital stay was shorter in the steroid group than in the control group [AfD=-0.98, 95%C/(-1.25, -0.71), P < 0.000 01]. Straight leg raising took less time in the steroid group than in the control group [MD=0.65, 95%C/(-0.86, 0.44), P < 0.000 01]. Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82, 95%C/(7.41, 2.23), P=0.000 3]. Knee society score and complication rate were not significantly different between the two groups. (3) To conclude, the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective.
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Objective To investigate the efficacy and safety of intravenous tranexamic acid(TXA)admin-istration combined with intra-articular"cocktail"+TXA infusion in primary total knee arthroplasty(TKA). Meth-ods 90 patients were randomly divided to experimental group A,control group B and control group C,30 cases in each group.There was no significant difference(P>0.05) in the preoperative general informations,such as age, sex,body mass index,hemoglobin,hematocrit,D-dimer,preoperative KSS score,knee activity ROM,VAS scores,operation time,time of using tourniquet. All the patients were intravenously injected with TXA 1g before using the tourniquet. After suturing the capsule,for the group A,100 ml of TXA and cocktail mixture(TXA 1g, ropivacaine 40 mg,epinephrine 0.1 mg,methylprednisolone 40 mg) were perfused into the articular cavity through the drainage which then be clamped.By the same ways,group B patients infused with tranexamic acid solution 100 mL(TXA 1g),group C patients infused with saline 100 mL.The total blood loss volume,drainage volume,intraop-erative blood loss,hidden blood loss,the change of hemoglobin and hematocrit in postoperative 3 days,blood trans-fusion,adverse reactions,the VAS scores at 6,12,24,72 h in the postoporative quiescent condition and the VAS scores at 12,24,72 h in the postoporative activity condition were measured and compared.Results The volume of total blood loss,hidden blood loss,drainage,were(685.7 ± 120.6)mL、(259.9 ± 162.0)mL、(151.5 ± 48.9)mL in group A,the decrease of hemoglobin and hematocrit at postoperative 3 d were(18.6 ± 3.2)g/L、(3.1 ± 1.3)% in group A,there was statistically significant(P<0.05) comparing with the control groups.The VAS scores of experi-mental group in the resting and the active state were lower than that in control groups(P < 0.05). Conclusion The application of intravenous tranexamic acid administration combined with intra-articular"cocktail"+TXA infu-sion can reduce the volume of postoperative total blood loss,drainage and hidden blood loss.Simultaneously,it can significantly alleviate the early postoperative pain,which is conducive to early rapid recovery,while not increasing the risk of thrombosis,and no adverse reactions.
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Objective To discuss postoperative analgesia effect of patient automatic controlled epidural analgesia (PCEA) and cocktail therapy (CT) after total hip replacement. Methods Eighty-eighty patients of selective total hip replacement were selected, and the patients were divided into PCEA group and CT group by random digits table method with 44 cases each. The postoperative resting state and active state visual analogue score (VAS), dosage of opioid, discharge time, postoperative complications, postoperative sleep quality score and hip joint mobility were compared between 2 groups. Results The resting state and active state VAS in PCEA group 12, 24 and 48 h after operation were significantly lower than those in CT group, resting state: (3.68 ± 1.45) scores vs. (4.23 ± 1.14) scores, (2.61 ± 1.04) scores vs. (3.92 ± 1.23) scores and (2.31 ± 0.97) scores vs. (3.56 ± 1.21) scores, active state:(4.54 ± 1.63) scores vs. (5.87 ± 2.11) scores, (3.51 ± 0.94) scores vs. (4.34 ± 1.07) scores and (3.01 ± 0.95) scores vs. (4.05 ± 1.17) scores, and there were statistical differences (P0.05). The dosage of opioid in PCEA group was significantly lower than that in CT group:(9.58 ± 5.35) mg vs. (11.27 ± 4.48) mg, and there was statistical difference (P0.05). Conclusions Choice of analgesic regimen of choice should not be made only according to the length of hospital stay. Individualized treatment is recommended. According to specific circumstances and needs of patients, patients with less anesthetics and a tendency to nausea should use PCEA, and for chronic pain patients CT may be more effective.
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OBJECTIVE:To evaluate the cost-effectiveness of 3 "Cocktail" therapeutic regimens in treating acute cerebral infarction(ACI).METHODS:141 patients with ACI were administered with Sodium Ozagrel + Cinepazide + Edaravone(Group A),Vinpocetine + Propylgallate + Deproteinized calf blood Extractives(Group B)or Sodium Ferulate + Buflomedil + Muscular Amino Acids and Peptides and Nucleosides(Group C)for 14d.Cost-effectiveness analysis in pharmacoeconomics was applied to analyze the therapeutic effects and costs.RESULTS:The total costs of 3 groups(A,B and C)were 5 970.67 yuan,4 865.11 yuan and 3 939.72 yuan,respectively,the efficiency rates were 82.98%,63.04% and 64.58% respectively,and the cost-effectiveness ratio were 7 195.31,7 717.50 and 6 100.53,respectively.CONCLUSION:Group A is preferable for ACI.